Primary and reversible Pisa syndrome in juvenile normal pressure hydrocephalus

Objective: To report a case of Pisa syndrome in a patient with idiopathic normal pressure hydrocephalus, who had never been exposed to psychotropic medications. Methods: A 26-year-old, Colombian, male patient, was referred because he had cognitive abnormalities, gait disturbances and urinary incontinence. This patient also displayed pleurothotonos. Neurofunctional evaluations of sensory and motor integration at peripheral and central nervous system levels were done. Idiopathic normal pressure hydrocephalus (NPH) was diagnosed. Results: Pisa syndrome disappeared after spinal tap drainage with further gait, balance and behavioural improvement. A brainstem-thalamocortical deregulation of the central sensory and motor programming, due to the chaotic enlargement of brain ventricles was thought to be the pathophysiological mechanism underlying this case. Conclusion: NPH must not be longer considered as an exclusive geriatric disorder. Further, uncommon movement disorders may appear with this disorder, which should be carefully approached to avoid iatrogenic and deleterious pharmacological interventions.